Provider Demographics
NPI:1316452667
Name:CMKDDS
Entity type:Organization
Organization Name:CMKDDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-685-1700
Mailing Address - Street 1:17721 DALLAS PKWY STE 116
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7338
Mailing Address - Country:US
Mailing Address - Phone:469-685-1700
Mailing Address - Fax:888-491-6582
Practice Address - Street 1:17721 DALLAS PKWY STE 116
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7338
Practice Address - Country:US
Practice Address - Phone:469-685-1700
Practice Address - Fax:888-491-6582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLE SLEEP SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty